Provider Demographics
NPI:1417410705
Name:FREMAREK, NICOLE (DO, MBA)
Entity type:Individual
Prefix:
First Name:NICOLE
Middle Name:
Last Name:FREMAREK
Suffix:
Gender:F
Credentials:DO, MBA
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1750 INDEPENDENCE AVE
Mailing Address - Street 2:
Mailing Address - City:KANSAS CITY
Mailing Address - State:MO
Mailing Address - Zip Code:64106-1453
Mailing Address - Country:US
Mailing Address - Phone:816-654-7000
Mailing Address - Fax:
Practice Address - Street 1:2861 NE INDEPENDENCE AVE STE 201
Practice Address - Street 2:
Practice Address - City:LEES SUMMIT
Practice Address - State:MO
Practice Address - Zip Code:64064-2379
Practice Address - Country:US
Practice Address - Phone:816-525-2840
Practice Address - Fax:816-525-2841
Is Sole Proprietor?:No
Enumeration Date:2019-04-12
Last Update Date:2024-11-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MO2024037892204D00000X, 207QS0010X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes207QS0010XAllopathic & Osteopathic PhysiciansFamily MedicineSports Medicine
No204D00000XAllopathic & Osteopathic PhysiciansNeuromusculoskeletal Medicine & OMM